Untidy Feminist Entanglements

In the 13th essay of the Legacies of Eugenics series, Margaret R. Eby shows how, during feminism’s first wave, white women physicians became the unlikely standard-bearers of eugenics.

By Margaret R. EbyMarch 15, 2026

• Gender & Sexuality

• History

• Politics

• Science & Technology

This is the 13th installment in the Legacies of Eugenics series, which features essays by leading thinkers devoted to exploring the history of eugenics and the ways it shapes our present. The series is organized by Osagie K. Obasogie in collaboration with the Los Angeles Review of Books, and supported by the Center for Genetics and Society, the Othering & Belonging Institute, and Berkeley Public Health.

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IN MARCH 2017, then–vice president Mike Pence tweeted a photo of himself at a table with members of the House Freedom Caucus discussing plans to repeal the Affordable Care Act (ACA) and replace it with the American Health Care Act (AHCA). A key issue was whether to repeal the ACA’s 10 “essential health benefits,” which include women’s health policies like maternity and newborn care as well as breast cancer screenings. Reactions to Pence’s post were swift and critical. “This is outrageous,” tweeted Democratic congressman Jim McGovern. “Not a single woman in the room as [Mike Pence and the House GOP] propose removing maternity coverage.” Democratic senator Patty Murray described it as “a rare look inside the GOP’s women’s health caucus.” Just months earlier, a similar photo had made the rounds on social media, with Planned Parenthood wryly captioning it “Donald Trump signs an anti-abortion executive order surrounded by men.” These statements assume that only women can adequately represent women’s reproductive rights and care.

The problem with this seemingly commonsensical position is easy to identify. One need look no further than Amy Coney Barrett. Confirmed to the Supreme Court in 2020, she effectively gave the lie to the notion that having “a woman in the room,” let alone several, resulted in better reproductive outcomes for women. Indeed, there is no consensus among women about what is “good” for women, or even about who can be called a “feminist.” The erasure of pro-life women is anti-feminist, say some. A pro-life woman can’t be a feminist, say others. Is a conservative woman who prioritizes family alongside her career a shining example of living one’s values, or does her life constitute an impossible compromise? It depends on whom you ask.

The term “compromise” crops up incessantly, as it did when Barrett voted alongside four other justices to overrule Roe v. Wade (1973). Even as she removed federally protected abortion access, her supporters cited her actions as representative of an authentic feminism with which they happily identified. Critics categorically decried Barrett’s stance and called her a “perfect messenger” to “trip the kill switch” on reproductive rights. Becca Andrews sarcastically declared:

[S]he’s an upper-middle-class, conventionally attractive white woman. She’s well educated, intelligent, accomplished, unquestionably poised. She’s a woman of faith, mother to seven children—two of whom are Black, adopted from Haiti—and she is a living, breathing example of a woman who Has It All, a mascot of suburban privilege. So, naturally, we are expected to conclude that as a woman who has found success in her career and her domestic life, she has only the best interests of other women and their health care in mind.

This tension—between the presumed representative character of women in power and the reality of their ideological diversity—is a common thread across reproductive health discourses. The tension stretches back to feminism’s first wave at the turn of the last century. At that time, three enormously consequential forces in the United States—female professional advancement, the rise of medical authority, and the business of nation-making—collided head-on, creating the conditions for white physicians to become the unlikely standard-bearers of eugenics. Understanding the moral untidiness of that moment is key to understanding our own.

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The front page of the August 29, 1915, issue of the Sunday New York Times Magazine juxtaposes two illustrations. On the upper left corner, a stork watches over a large egg, while on the upper right, a baby, turning its back to the reader, holds a sign that reads “VOTE.” Below the title line is more of the same: a photograph depicts a suffragist in a sash speaking to a crowd, and a second image portrays a beatific young mother holding an infant. The headline below those images reads: “The Woman Movement and the Baby Crop: Effects of It are Becoming So Appalling as to Threaten Seriously the Perpetuation of the Nation, According to Students of the Question.” The subsequent, deeply alarmist article by Mr. and Mrs. John Martin decries how the growing number of women with college degrees is harming the country’s birth rate. Women pursuing higher education, they declare, intend to live unnaturally, and in the manner of men, “directed consciously according to the gospel of the woman’s movement.” The Martins cite statistics that 69.8 percent of women with “native white parentage” marry, while only 42.2 percent of college-educated women do. They saw this gap as disastrous for the country: “The ablest and best-trained women are to be enticed, by college education first and by high salaries in business after, to sterility. […] We are to establish an unnatural selection of the fittest to die and the unfittest to survive.”

The Martins’ claims were motivated by their politics but also supported by statistics. Women’s educational opportunities had indeed rapidly increased since 1870, when, according to activist Mariam K. Chamberlain, “only 30 percent of colleges were coeducational”; by 1900, 70 percent of colleges accepted women, who made up nearly 20 percent of college graduates. Data collected by women’s colleges showed incontrovertibly that higher education had an inverse relationship with the likelihood of marrying and raising children. Nellie Seeds Nearing, a Bryn Mawr–educated author and women’s rights advocate, grudgingly conceded the point in her 1914 University of Pennsylvania thesis “Education and Fecundity.” As she also points out, however, “the figures only show the existence of two separate phenomena of continually increasing importance […] The entire trend of our higher education of women should be, and I confidently believe will be determined in large measure by its effect upon fecundity.” Nearing believed that educated women should not, in the long term, abdicate their duty to “maintain the population.” Despite this exhortation, an economist at Massachusetts Agricultural College (today’s UMass Amherst) wrote in the Journal of Heredity the following year that education and race suicide were inextricably linked: “Women’s colleges have heavy responsibility for disappearance of old American stock in the United States.”

College-educated women thus became an easy target. Theodore Roosevelt, in his 1911 essay for The Outlook, “Race Decadence,” turned the screw:

Exactly as the measure of our regard for the soldier who does his full duty in battle is the measure of our scorn for the coward who flees, so the measure of our respect for the true wife and mother is the measure of our scorn and contemptuous abhorrence for the wife who refuses to be a mother.

Over 100 years before the term “tradwife” became part of the lexicon, women who refused to buy into a breeding mandate were portrayed by an American ex-president as objects of contempt and, in his speeches, as criminals against “the race.” A sense of patriotic duty demanded, then, that they relinquish their professions to occupy themselves with the reproduction of white America.

These critiques posed a particular challenge to women physicians. In 1849, Elizabeth Blackwell had become the first woman in the United States to receive a medical degree, and Rebecca Lee Crumpler then became the first Black woman to do so, in 1864. Since then, the number of women physicians incrementally edged up—to around 10 percent in 1914—and along the way, women were able to found their own medical associations, journals, and professional clubs. But around their heyday in the years immediately preceding World War I, the medical profession at large was experiencing an unrelated crisis of authority: the status of physicians was in decline, and competing factions battled over the direction the profession should take, with medical education one key site of contention. Because state licensing boards were escalating their requirements, some medical schools shut their doors while others increased their fees. Yet others stayed open by misrepresenting their compliance with regulations.

The Carnegie Foundation for the Advancement of Teaching commissioned educator Abraham Flexner to travel across the country and collect data on medical schools’ curricula, facilities, and assessment processes. The Flexner Report, published by the foundation in 1910, was shocking in its revelation of the extent of institutional fraud. One-third of operating medical schools had to shut down as a result of that report, which meant that the number of graduates decreased from around 4,400 in 1910 to roughly 3,500 in 1915. The number of practicing women physicians stalled and then declined. In Minneapolis, for example, 6.6 percent of practicing physicians in the city were women in 1880, rising to 19.3 percent in 1900 before dropping back to 7.0 percent in 1930. Likewise, in Boston, 18.2 percent of physicians were women in 1900, dropping to 8.7 percent in 1930. As Mary Roth Walsh, a historian of women in medicine, wrote in 1977, “seventy-six years and two women’s liberation movements after 1900, women still have not been able to match the earlier percentages.” While scholars agree that many factors were behind this attrition, the shuttering of 92 medical schools between 1904 and 1915 undoubtedly had an enormous impact. Nearly 20 women-only medical schools opened between 1850 and 1895: by 1910, only two remained.

As the number of women physicians dwindled, so did their perceived legitimacy. The public grew more reluctant to be treated by them, citing a lack of confidence in women physicians. They were too new to the field, it was said, and lacked the experience of male doctors. For nonwhite women physicians, additional roadblocks were in play. Isabella Vandervall, a Black woman physician who graduated in 1915 from the New York Medical College for Women at the top of her class, found that new rules requiring an internship to complete one’s medical training left her at a distinct disadvantage. After being rejected by four different hospitals, including the institution at which she had trained, Vandervall decried the consequences of so much discrimination in a report for The Woman’s Medical Journal: “[M]any negro women do not wish to be attended by male physicians, and do not wish to take their children, especially their girls, to one. Yet what are they going to do if they are to be denied women physicians of their own race? They must be treated, yet to whom can they turn?”

Public opposition, along with Roosevelt’s impassioned speeches around maternal duty and “race suicide,” might very easily have had a disastrous effect on women’s representation in medicine. But instead, something entirely different happened: women physicians survived, and some thrived. White ones sensed an opportunity, transforming the barriers to their participation in medical life into gateways for their entry alone. In a nutshell, they actively and rhetorically participated in excluding Black women doctors. To the demand for more attentive and productive mothers, they responded with a “scientific motherhood” that emphasized eugenic ideals of quality over quantity. They addressed anxiety about the fecundity of recent immigrants by suggesting that more jobs be created for women physicians to counsel immigrant women on contraceptive strategies and proper “American” mothering. They repurposed eugenic logics to improve maternal and infant welfare. During the proverbial “dark ages” of women in medicine, these strategies enabled them to gain authority within reproductive and family health.

What made the transformation in their status possible? Partly, it was their complex complicity in the racial project so central to nation-making in the United States. The symbolic American mother—“native-born” and white—was the purveyor of racial purity. Black mothers might wish their children to be seen by Black women physicians, but no matter. They now had to be seen by white ones, who could draw on their race to legitimize their claims. In situating themselves as allies in the eugenic struggle, white women physicians made a devil’s bargain of sorts, offering their expertise in exchange for continued access to medical authority.

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During this transitional period, these women physicians also challenged the allegedly inimical effect of higher education on native fertility. Margaret Hackedorn Rockhill, editor and co-founder of The Woman’s Medical Journal, gamely declared that college (and training in eugenics) improved women’s capacities for motherhood:

No college course could kill the mother instinct, but it can add wisdom to that instinct. Higher education means higher motherhood. A knowledge of eugenics will do much toward the production of healthy children. Certain truths must be more generally taught. They are vital to our welfare as a nation. […] The college woman […] understands the importance and responsibilities of motherhood, and does not underestimate its rewards.

Rockhill was not alone in taking this approach. “In the name of the future of the race, motherhood demands recognition as a profession not surpassed in importance in all the activities of life,” wrote Evangeline W. Young, a graduate of Tufts College Medical School, who founded the School of Eugenics in Boston in 1912. Defining motherhood itself as the noblest profession served to dissolve the seeming antagonism between women’s work within the family and their medical work; both forms of work could be couched as complementary services to the nation. Underscoring this point, Dr. Clelia D. Mosher argued, in a paper presented at the 1920 International Conference of Women Physicians, that “she who is best prepared, physically, mentally, ideally, for the duties of home is also prepared for all her obligations as an individual, as a citizen and as a member of the industrial and social order. […] There is no antagonism between her duty to the race and her own development.” Ergo, white women’s professional ascendance was deeply and felicitously consonant with the eugenic project.

Before the centralization of medical authority circa 1900, informal networks of female midwives and family members had authority over reproductive care. In a 1915 editorial for The Texas Medical News, Dr. Lydia DeVilbiss boldly argued that formalized medicine should take over contraceptive matters. She had received a letter from a minister’s wife who asked, “Where are we to turn for advice except to the medical profession?” DeVilbiss responded: “Where indeed, except to the drug store, the charlatan, the unlicensed midwife, or the saloon club, as so many do.” White women physicians should, she said, step into the breach. DeVilbiss took up this mantle of medical authority, serving as the first director of child hygiene in both Kansas and Georgia, and dispensing advice as the medical director of the “Better Babies” department of the popular magazine Woman’s Home Companion. She wrote books and articles on birth control and was active in her local women’s suffrage association. She was also an open racist and eugenicist who founded a clinic in Miami devoted to maternal health where she performed surgical sterilizations on Black women she deemed unfit for motherhood.

My point here is that these issues were inextricably linked—even if uncomfortably so from the perspective of current sensibilities. Midwifery was rejected because it fell outside establishment standards. Medicine was embraced because of the authority it conferred. White womanhood was deployed as a tool for the subjugation of other women. These three truths coexisted, rhetorically bound together in one national project.

The strategy worked. As Dr. Eleanor C. Jones, president of the Alumnae Association of the Woman’s Medical College, said in her 1913 annual address,

I believe that the outlook for women physicians was never so bright as at the present time. There is positive demand for their services in public and private institutions for women and children—such as insane hospitals, feeble-minded institutions and reformatories. […] There is a crying need for women physicians who can lecture on eugenics, sex-hygiene and allied subjects in preventive medicine to women’s clubs, girls’ schools, factories and social centers.

In short, white women physicians could now portray themselves both as having a unique relationship to eugenics, sex hygiene, and family life and as having access to spaces not easily accessible to male physicians. They could pitch themselves as capable of doing the practical work of spreading eugenic knowledge while at the same time striking a bargain with critics of women in medicine by positioning themselves as foot soldiers on the front lines of the pending “population emergency.” Dr. Isabelle Thompson Smart, a medical examiner of mentally “defective” children for the New York City Department of Education, declared that white female doctors possessed moral qualities specific to their gender, which enabled them alone to redress blight within the body politic. In an invited lecture at the New York Normal School for Physical Education in 1911, she said:

There is a great wave of indignation sweeping over the country at large at the appalling number of deficient children found each year in our schools […] it is just here that the physicians who have the right sense of altruism, the right sense of justice and truth can be of the greatest service. Personally, I think there is a big work in this special field for the woman physician.

The “big work in this special field” included a range of initiatives. White women physicians zealously went to work founding Better Babies contests and serving as “baby experts” when selecting winning entrants; they used eugenics to argue for increased protections against sexually transmitted diseases as well as improved pre- and postnatal healthcare; they suggested that, rather than condemning women for having fewer children, society should be condemned for making motherhood so undesirable; and they cited their close connections with their women patients as indicative of their unique, gender-based propensity for effective eugenic advocacy. In a now-familiar refrain, they positioned themselves as living examples of “having it all”: newspaper coverage of the 1914 Iowa Medical Women’s conference reported that “opponents of woman suffrage” are “controverted by Dr. [Florence] Sherbon,” who “not only is an ardent suffraget [sic], not only a practicing physician with a large clientele, but […] the mother of two of the healthiest boys in the state. In short, Dr. Sherbon is a mother, an eugenist, a suffragist and a physician. Moreover, she is proud of her boys.”

What, then, are we to make of white women physicians who opened doors to women in medicine, contributed toward improved care for women and children, celebrated women’s participation in civic and professional leadership, and were avid eugenicists? Nowhere has the paradoxical nature of this issue been more clear than in the ever-complicating legacy of Margaret Sanger, founder of Planned Parenthood. Long heralded as a feminist icon, a radical who ran afoul of the law and won, Sanger has enjoyed a seat at the table of women changemakers and revolutionaries. Yet she, too, enthusiastically collaborated with eugenicists and worked to maintain medical authority over reproductive choice. Although Sanger was a nurse rather than a physician, she was instrumental in ensuring that contraceptives became available only when prescribed by a doctor (a key element of contraceptive access that persists to this day). Other women organizing for birth control disagreed with Sanger’s stance. Mary Ware Dennett, who found Sanger’s reliance on medical authority to be elitist and out of touch, consistently argued that birth control access should be unrestricted.

Sanger’s biographers are forced to grapple with an unsettling body of evidence. Was Sanger an agent of eugenics, or were her ties to eugenicists part of the “marriage of convenience” that helped popularize her movement for women’s contraceptive autonomy? In the period following George Floyd’s murder in Minneapolis, when many institutions publicly grappled with their histories of racism, Planned Parenthood of Greater New York “disavowed” Sanger and removed her name from their Manhattan health clinic as “a necessary and overdue step to reckon with [their] legacy and acknowledge Planned Parenthood’s contributions to historical reproductive harm within communities of color.”

But despite periodic reckonings with feminism’s uneasy entanglements, the refrains of this history echo to the present day. Eugenics shapes who we look to for reproductive expertise, and who has the tools to support reproductive decision-making. It informs our ideas about who should be “in the room” when decisions about reproductive healthcare get made, and what kind of woman is a “good” representative. Billionaire-driven obsessions with pronatalism and genetic improvement are accelerating these themes. Among proponents of the right-wing “Great Replacement” theory, women’s educational, economic, and social success has, as Roosevelt put it a century ago, entailed a dereliction of their duties as wives and mothers. White Americans are being replaced, they argue once again, because white American women are not keeping pace with nonwhite mothers.

The resulting movement to “reset” women’s priorities is gaining steam through social media. In the United States in the early 1900s, the footwork of reproductive governance was ceded to women physicians, with the understanding that they would be more effective at policing other women than their male counterparts would. It is thus unsurprising that the most effective leaders of contemporary movements for women-as-weapons in the global fertility rush are white women themselves. Growing numbers of young women look to conservative influencers to help them “remake their lives” according to the “less burnout, more babies” model. These influencers promise a deeper calling, and a stronger sense of fulfillment, to women who eschew careers and higher education in favor of starting their families early. In a 1917 edition of her “Ideas of a Plain Country Woman” column for The Ladies’ Home Journal, Juliet V. Strauss (identified only as “The Country Contributor”) argues that the problem of “race suicide” can only be addressed when women can “revitalize American society and national life by abandoning our notion of all getting ‘up’ in the world on a materialistic basis.” A century later, the booming tradwife movement made headlines when blogger “Wife with a Purpose” announced a “white baby challenge”: “Match or beat me!” she wrote, encouraging her followers to top her record of six births.

Amid this renewed movement to promote and protect white motherhood, the reality of reproductive care in the United States tells a grim story. A 2023 report on maternal mortality rates found that Black women experience a pregnancy-related death rate of approximately 50.3 per 100,000 live births—more than 3.5 times higher than white women. And while mortality rates for white and Hispanic women decreased from the previous year, the gap for Black and Indigenous women remained, with causes often linked to quality of care and structural inequities. This gap is mirrored in the physician workforce: although women made up around 36 percent of this workforce in 2019, only 7.4 percent of these 340,018 women physicians were Black (a mere 2.8 percent of physicians overall). A century after Isabella Vandervall’s entreaty to the medical establishment to invest in Black women doctors, there is much work still to do.

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As Sophie Lewis writes in her analysis of reactionary and hateful forms of feminism, arguments that “‘women are horrible’ and ‘women are not horrible’ are really two sides of the same coin.” Lewis finds that “the one claim merely reverses the other, leaving intact the premise that gendered oppression is some kind of public relations matter—a question of people misjudging the group’s inherent value. […] Why would women not be horrible; aren’t they part of history?”

Part of excavating the history I’ve described here involves surfacing the threads that link our past with the present day, and then imagining the utopias and dystopias that might await. What might 20th-century eugenics have looked like had it faced more dissent and less accommodation? What might eugenics look like in the next century if we dissent from it now? We should never forget that successive generations of white women—feminists or not—have exercised their relative power to shape reproductive autonomy for their own ends. History is never ideologically tidy. People pursue their aims in the context of their times, and women are no different: they are part of history, as Lewis puts it. Eugenics will assuredly take up new disguises with each iteration of social and technological “progress.” Our best chance of unmasking its subterfuges is to engage in bold acts of recognition, and to spot its recurrence even in ourselves.